Lower Face and Neck Lift

Rejuvenation of the Aging Face and Neck

Dr. Hohuan specializes in surgical rejuvenation of the aging face and neck. His extensive training background allows him to focus solely on plastic surgery involving the face and neck. While at Yale, he trained with one of the pioneers of the deep-plane face lift. While in Virginia, he trained with one of the premier facial plastic surgeons in North America, learning the Micro Mini Lift. These two approaches allow him to provide the full-spectrum of plastic surgical techniques and methods to rejuvenation of the aging face.

During your consultation with Dr. Hohuan, he will meet with you and discuss your aesthetic goals and philosophy. You will review photographs together and discuss options for rejuvenation of the face.

Some patients with early jowling and early aging in the neck may be candidates for the Micro Mini Lift.

This entails shortened incisions around the ear and affords the ability to tighten the SMAS in a minimally-invasive fashion. This will improve the lower jawline and upper neck contour.

Patients with more advanced aging in the lower face and neck, or patients who have had facelifts previously are typically candidates for the deep-plane facelift. This involves incisions around the ear and into the hairline behind the ear to maximally reposition muscle and remove excess, photo-damaged skin. It is often combined with procedures under the chin to contour fat, and to tighten the muscles underneath the chin to give a smooth, elegant contour.

Before and After Facelift and Necklift

Diagnosis: Steatoblepharon of Lower Eyelids, Moderate to severe laxity of jowl and neckProcedure: Deep plane midface, lower face, and neck lift, with platysma division and plication, as well as Transconjunctival Conservative lower eyelid blepharoplasty with SOOF lifting.Techniques: release of all facial retaining ligaments including orbitomalar, zygomatic-cutaneous, mandibular, masseteric, and platysma-cutaneous ligaments, followed by repositioning of muscle and fat pads.

Questions:

1. What is your overall philosophy with surgical treatment of the aging face and neck?

There are several core ideas/values that inform everything I do when treating the aging face and neck.

For one, I strive not to change how a person fundamentally looks, but to turn back the clock so that they feel like a younger, more youthful version of themselves. Most of my patients report looking about 12-15 years younger.

Secondly, the results should look natural, and imperceptible. Some procedures/surgeries render patients looking unnatural, surprised, quizzical, overly pulled. This is a disservice to the patient. There is a range of results that are acceptable. The importance of finding a surgeon with the right experience, training, and judgement, as well as the consultation where we discuss what is and isn’t possible are vital to achieving results that are natural.

2. What is the deep plane face lift?

The deep plane facelift is a more advanced facelifting technique that gives the most natural results. Many surgeons use techniques that reposition the skin, or pull on the layer below the skin to reposition the jowl or to diminish aging platysmal bands in the neck. Although these techniques work in some, they can lead to wide scars, abnormal orientation of the ears, early recurrence of jowls and platysmal bands, and abnormal orientation/pull of the lips. The deep plane facelift technique completely mobilizes the muscle and fascial layer below the skin (SMAS), allowing us to completely mobilize the jowl and muscles of the lower face and neck. In so doing, we are able to reposition them to their earlier location before the ligaments that held them in place weakened with age (platysma-mastoid ligaments, parotid-masseteric ligaments, zygomatico-cutaneous ligaments). This gives the most natural results because we are literally reversing the aging process by repositioning the actual structures that lead to the physical expression of aging on the face.

3. Why don’t more surgeons use this technique?

This technique is a more advanced technique that requires extensive knowledge and comfort with the anatomy of the facial nerve. It requires careful dissection and exposure of the covering of the facial nerve branches. Facial nerve anatomy is an integral part of my training in treatment of parotid tumors and cancers. The experience and mentors I’ve had have given me a deep comfort with the anatomy and technique. My double-board certification in both facial plastic surgery and head/neck surgery reflect this.

4. What are platysmal bands?

Platysmal bands are the cords of muscle that run down the middle of the neck that often show with age. There are different patterns of platysmal bands, where some are located closer together and some are located wider apart. Platysmal bands that are located closer together are often easier to treat, because they can be brought together easily in the midline, creating a smooth and continuous contour underneath the chin and jawline. When combined with a deep plane facelift, this gives the most powerful results for natural rejuvenation of the jaw and neckline.

When the platysmal bands are wider apart, they often require more manipulation to achieve a smooth contour. This can usually be done with advancement of the edges toward the midline after creating releasing incisions in the platysma muscle low in the neck, and sometimes laterally in the neck underneath the ear lobe.

5. What are jowls?

Jowls are the sagging bags of skin, fat, and muscle that appear with age over the jawline around the mouth and nasolabial (melolabial fold). They are due to a combination of weakening and relaxation of the zygomatico-cutaneous ligament, as well as the parotido-masseteric ligament that allow the malar and buccal fat pads to descend downward. The best way to address this is to mobilize the jowl completely from underneath, then reposition it up and back where it was prior to the descent that occurs with aging/relaxation of the facial ligaments. This is why facelifting techniques that only pull on the skin or the layer just beneath the skin fail sooner: they do not reposition the jowl. Only the deeper techniques allow this.

6. What is the Micro Mini Lift?

The Micro Mini Lift is an abbreviated form of a traditional facelift technique. It is ideal for younger patients in their forties and fifties who have mild to moderate jowl formation in the jawline and neck. The biggest advantage is the shorter downtime, with most patients reporting 7-10 days before they are ready to go back to work and resume social functions. Additionally, the incisions are shorter, with a small incision in front of the ear and behind the ear. This access incision still affords comprehensive manipulations of the SMAS layer, albeit not as extensive as the deeper plane facelift technique.

7.What is the standard downtime with a Lower Face and Neck Lift

As a general rule, it takes about 2 weeks for patients to feel comfortable going back to work, and 3 weeks for more personal or intimate social encounters such as a family member’s wedding. Bruising and swelling vary between patients, but is moderate for the first week or so, gradually subsiding over the first 2-3 weeks. After 7-10 days, slight bruising can be covered with makeup.

8. Is the procedure painful?

Most patients report mild to moderate amounts of pain over the first week, which generally subsides over the second week after surgery. Cold compresses are used over the first couple of days after surgery, followed by warm compresses after the third post-operative day. This helps keep swelling to a minimum, and hence, pain as well. We give our patients low-dose narcotic medication, and encourage ibuprofen for breakthrough pain.

9. What can I expect regarding my scars?

I perform all incision planning and place every suture. Most if not all of my patients are very happy with the appearance of the scars. By one month, they will be hardly noticeable, and by 2-3 months, they should be very difficult to make out unless looking under a bright light. There can be mild redness over the incision for the first couple of months that can be easily covered with makeup. I utilize a retrotragal incision to maximally camouflage the scar. Additionally, the incisions in front of the ear and behind the ear run into the hairline, so that hair grows through the incision providing additional camouflage. Post-operatively, I manage the incisions carefully to ensure they are healing appropriately. This is done with special tape, as well as selective application of steroid injections to manage any instances of hypertrophic scarring. We recommend that all patients regularly use medical grade skin care, as well as moisturizers to optimize the healing and color of their scars. Our office has a private line of skin care that our patients can take advantage of.

10. Can the deep plane facelift or micromini lift be combined with any other procedures?

Yes. With the exception of rhinoplasty, most other surgical procedures aimed at rejuvenation of the aging face can be combined with the deep plane facelift, as well as the micro-mini lift. These include eyelid rejuvenation, brow lifts, buccal fat removal, chin augmentation, filler to the lips and midface.